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Improving the psychological recovery of ICU patients

Critical care nursing researcher Professor Leanne
Photo: Critical care nursing researcher Professor Leanne Aitken
Australian researchers will examine whether providing critically ill or injured patients with information such as an Intensive Care Unit (ICU) diary or discharge summary will help improve their psychological recovery.

Researchers have begun recruiting about 100 patients at Brisbane’s Princess Alexandra Hospital (PAH) for the study, which is also hoped to be replicated in the United Kingdom as part of a collaboration with hospitals in London and Dundee, Scotland.

In recent years, the focus on the physical survival of patients admitted to the ICU has shifted to also include their psychological and cognitive recovery.

Research shows about a third of ICU patients develop psychological problems after their ICU discharge, and experience depression, anxiety, post-traumatic stress symptoms or post-traumatic stress disorder.
Critical care nursing researcher Professor Leanne Aitken, who holds visiting appointments at Griffith University and Princess Alexandra Hospital and is now a Professor of Nursing at City University in London, says providing patients with information that details their ICU experience may improve their psychological recovery and help process their memories of ICU.

“Quite a number of ICU patients have gaps in their memory - they don’t remember their time in ICU or they have some really weird memories about it, with lots of delusions and hallucinations,” she says.

“The thought is that, for some, filling in those gaps will help them get rid of the anxiety and depression and post-traumatic stress that they’re experiencing. The biggest problem is we don’t know who will benefit from what.”

While not standard practice, ICU diaries have been used as interventions in Europe, particularly in Scandinavian countries, and in the UK.

Professor Aitken’s previous research, analysing literature regarding the use and impact of diaries on ICU patients, revealed a range of models have been used to create diaries, which are often completed by staff and family members to provide the patient with a record of events during their ICU stay.

“On the surface, that seems a great idea and the diary is given to the patient at some point after ICU and they can read it,” Professor Aitken says.

“Some patients love it but for other patients that actually causes them more stress because it suddenly becomes apparent what they’ve been through - how sick they were and, for some, how much they put their family through as well. So, for some, that isn’t the right intervention.”

The review examined 11 studies using ICU diaries. While the findings were positive, there were inconsistencies across the studies’ measures and methods.

Other research has examined the feasibility and effectiveness of a critical care discharge information pack, written in lay language, for patients and their families.

Professor Aitken, a Fellow of the Australian College of Critical Care Nurses (ACCCN), says research in the field is still in its infancy, and more evidence is needed to support the effectiveness of interventions, such as diaries and discharge summaries, for ICU patients.

The new study will investigate using ICU diaries, completed by family, friends and ICU staff, or discharge summaries compared to standard care at PAH ICU, which includes limited psychological support.

Patients who experience psychological distress after ICU discharge will be able to choose their intervention while those who are not distressed will be randomly allocated to the interventions.

Researchers will then measure the patients’ psychological health post-ICU at both the three and six month mark.

Professor Aitken says the research aims to explore patients’ perceptions of receiving information about their ICU admission.

She hopes the results will provide vital, new knowledge that will direct research into ways to improve care in Australian ICUs.

“We know that there’s a close relationship between psychological health and physical health, so if a person is feeling really down or depressed or stressed or anxious then they may not want to get moving with their physical health, and may delay getting back out to work and back into society.

“If we don’t get this right, then the implication of critical illness is not just while they’re in intensive care or while they’re in hospital, but it’s ongoing for months and for some years, and that obviously costs them in terms of their ability to enjoy life as well as the costs associated with accessing health care.

“I think this is an area where you can make a huge amount of difference to a patient - to understand what they’ve been through and feel as if they’ve got the tools to get on with living life again.”

Professor Aitken says it’s imperative ICU nurses and staff as well as staff on other wards, post-ICU, look beyond the patients’ physical injuries or illness.

“We need to be taking some responsibility within the hospital for how we equip our colleagues in the wards to be providing that information to our patients as well,” she says.

“Is that by giving our patients a discharge summary soon after they’ve left ICU, that they can read while they’re in the wards, so that the nurses on the wards might be able to answer some of those questions?

“Or if they see somebody that’s really struggling, for nurses to call the ICU and say - can somebody come down and talk to this patient?

“At the moment, if a patient is physically having problems when they’re in the wards, so struggling to breathe or low blood pressure or something like that, there’s a very clear process for wards to seek support for the patient - they can call support from the ICU."

There’s not the same level of support for people who are struggling psychologically, Professor Aitken says.

“We need to get better at recognising that’s just as important in some ways.”

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Karen Keast

Karen Keast is a freelance health journalist who writes news and feature articles for HealthTimes.

Karen regularly writes for some of Australia’s leading health news websites and magazines.  In a media career spanning 20 years, Karen has worked as a senior journalist in newspapers and television. She has covered the grind of daily news and worked as a politics reporter at countless state and federal elections.

Since venturing into freelance writing five years ago, Karen has found her niche in writing about the health sector for editors, businesses and corporations.

Karen has interviewed the heads of peak health organisations in Australia and overseas, and written hundreds of news and feature articles covering the dedicated work of health professionals who tread the corridors of hospitals and health services, universities, aged care facilities and practices, day in and day out.

Follow Karen Keast on Twitter @stylemywords